A bogeyman haunts the recurring nightmares of six-year-old Miguel,* who was born and spent his earliest years in a conflict-ravaged corner of Colombia.

Now resettled in Canada, he picks up modeling clay at an art therapy session and makes a cage. With delicately placed Play-Doh nails, he contains the “villain” within it, his therapist explains.

“The dots made in the Play-Doh symbolize nails so that the villain does not come out and stays inside,” says Julia,* who leads the weekly sessions that last for an hour each.

Miguel’s grandmother was killed by rebel combatants in Colombia’s 52-year-old civil war, which has uprooted 7 million people within the country and driven hundreds of thousands of others – like Miguel and his mother and two brothers – into exile.

“Mental health issues can be an abstract concept for people who have not had a direct contact with refugees."

The imaginary story unfolding within the safety of the calm, bright room at a Montreal nonprofit is an approach created by the boy to cope with fear and anxiety that has followed him throughout his short life. In this activity, his therapist explains, he becomes the one who holds the power and makes sure the villain will not scare him anymore.

There are a record 65.3 million people displaced worldwide by violence and persecution. While there are no firm figures for the numbers affected by mental trauma, it is well documented that refugees and asylum-seekers in Canada and around the world have previously experienced bad events, which include war, torture, violence, targeted persecution, forced labour and family separation.

Research suggests that these adverse experiences may contribute to refugees developing a constellation of mental health issues, such as depression and anxiety, behavioral problems and trauma-based illnesses, including Post Traumatic Stress Disorder. Some, like Miguel are getting help.

The youngster’s psychological symptoms started to manifest when he was two years old, his mother, Maria,* explains. At the time, she and her three sons lived at home in Nariño, in south-east Colombia, an area caught up in the conflict – currently suspended by a ceasefire as rebels and the government seek a peace deal.

While she was pregnant with Miguel, Maria’s own mother was killed by rebels, which left her feeling emotionally overwhelmed. Rebel violence forced the family to flee to neighbouring Ecuador, shortly before Miguel turned three, adding to his distress.

“His behavior became unpredictable as he grew up. I knew we had to do something. He would cut himself and have violent outbursts of anger with no apparent reasons,” Maria recalls. “He was afraid and anxious all the time. He couldn't be around people. He couldn’t even play with kids his own age.”

Unable to cope, Maria decided to seek help in Quito, the Ecuadorian capital, but psycho-social support was in short supply. When the family was resettled to Canada in 2014, a diagnosis of trauma-related disorder was made and Miguel finally got the help he needed during the visits to RIVO, the Montreal-based non-profit organization that provides expert help to refugees suffering the consequences of violence.

At RIVO, Miguel can draw, do crafts, play with modeling clay and work through his overwhelming fears with his therapist.

“Mental health issues can be an abstract concept for people who have not had direct contact with refugees suffering from psychological distress,” says Veronique Harvey, a spokesperson for RIVO and a therapist herself.

"It is so important to increase public awareness of the emotional wounds so as to make them visible."

“This is why it is so important to increase public awareness of the emotional wounds, so as to make them visible in the eyes of the public and governments. We can’t always understand what those with mental illness have gone through, but we need to listen, support and help them rebuild their identity and self-esteem,” she adds.

UNHCR, the UN Refugee Agency, recognizes mental health and psycho-social support as a core part of its protection mandate. It strives to integrate some basic forms in its programming. Ideally, psychological support for children like Manuel should already start in the countries of first refuge.

The therapy he receives in Montreal seeks to allow Miguel both to confront and work through his agonizing feelings and better cope with them. In addition to managing fear with modeling clay, drawing enables him to address feelings of isolation and anger, and make the connection between his behavior and his interactions with others.

Initially, Miguel was reluctant to participate in the therapy sessions, which have now been going on for nine months. In some small measure of the benefit they have brought him, he is concerned that the activity is coming to an end. He has gotten used to working with his therapist, Julia, and feels safe with her.

“I am trying to explain to him that it does not depend on me,” says mother Maria, who is also appreciative. “I keep telling him that we will be checking with Julia about her plans to end the therapy.”